Do Women taking Hormone Replacement Therapy (HRT) have a Higher Incidence of Breast Cancer than Women who do not?

An estimated one third of all American and United Kingdom women take hormone therapy. In sharp contrast to these numbers, as many as one half of women diagnosed with breast cancer have taken hormones. Little additional information is available regarding the risk of breast cancer and even less is known about the association between hormone therapy and fibrocystic (FCD) disease or atypia of the breast. Three hundred women between 30 and 50 years of age were enrolled in this study, including 120 taking hormone replacement (HRT) therapy and 180 women who had never taken hormone therapy. These women were divided into four categories including those with normal breast tissue, those with FCD disease, those with cellular atypia, and those with breast cancer. Another group of women were also identified who had breast implants. Using breast enhanced scintigraphy (BEST) imaging, changes in breast tissue were determined and compared according to the use of HRT. Forty percent (122 of 300) had “normal” breasts, of whom 68.8% (84 of 122) did not take HRT. This accounted for 46.7% (84 of 180) of the women not taking hormone therapy, while only 31.7% (38 of 120) of the women taking HRT had normal breasts. This difference was statistically (p.001) significant. There was a greater incidence of breast abnormality in women taking HRT and a lower incidence in pathology among women not taking HRT when cumulatively analyzed for FCD, cellular atypia, and breast cancer. This difference was statistically significant (p.001) for women with breast cancer where 62.5% (10 of 16) were women taking HRT. Although the study was relatively small, it is the first such study to compare a continuum of changes in breast tissue according to the use of HRT. The study suggests that the initial empirical observations regarding higher incidence of HRT among women with breast cancer, may have a relationship to underlying changes in breast tissue that are associated with differences in mitochondrial content and activity. Further investigation is needed.

Aluminium and the human breast

The human population is exposed to aluminium (Al) from diet, antacids and vaccine adjuvants, but frequent application of Al-based salts to the underarm as antiperspirant adds a high additional exposure directly to the local area of the human breast. Coincidentally the upper outer quadrant of the breast is where there is also a disproportionately high incidence of breast cysts and breast cancer. Al has been measured in human breast tissues/fluids at higher levels than in blood, and experimental evidence suggests that at physiologically relevant concentrations, Al can adversely impact on human breast epithelial cell biology. Gross cystic breast disease is the most common benign disorder of the breast and evidence is presented that Al may be a causative factor in formation of breast cysts. Evidence is also reviewed that Al can enable the development of multiple hallmarks associated with cancer in breast cells, in particular that it can cause genomic instability and inappropriate proliferation in human breast epithelial cells, and can increase migration and invasion of human breast cancer cells. In addition, Al is a metalloestrogen and oestrogen is a risk factor for breast cancer known to influence multiple hallmarks. The microenvironment is established as another determinant of breast cancer development and Al has been shown to cause adverse alterations to the breast microenvironment. If current usage patterns of Al-based antiperspirant salts contribute to causation of breast cysts and breast cancer, then reduction in exposure would offer a strategy for prevention, and regulatory review is now justified.

Benign breast diseases, contraception and hormone replacement therapy

The term benign breast disease includes a wide and heterogenous spectrum of lesions different for histology and natural history. Approximately 70% of women who undergo a biopsy for benign breast disease have non-proliferative lesions with no increased risk of breast cancer, 26% have typical hyperplasia which is associated with a two-fold increased risk, and only 4% have atypical hyperplasia which is associated with a five-fold increased risk. The data on the effect of steroid hormones on benign breast disease come from observational studies with several potential bias. Most papers have reported that oral contraceptives protect against benign breast disease, whereas some others have suggested that effects of pill are not yet fully clear. As far as hormone replacement therapy (HRT) is concerned, some studies have shown an increased incidence of benign breast disease in long-term HRT users, whereas other investigations have found either no effect or a protective effect. The use of HRT does not appear to influence the clinical pattern of benign breast disease in postmenopausal women, although enlargement of pre-existing cysts or fibroadenomas has been sometimes reported. The limited available data failed to detect a deleterious effect of HRT use in women with benign breast disease, even in those with increased breast cancer risk due to a family history or high-risk benign breast conditions.

Environmental oestrogens, cosmetics and breast cancer

The established role of oestrogen in the development and progression of breast cancer raises questions concerning a potential contribution from the many chemicals in the environment which can enter the human breast and which have oestrogenic activity. A range of organochlorine pesticides and polychlorinated biphenyls possess oestrogen-mimicking properties and have been measured in human breast adipose tissue and in human milk. These enter the breast from varied environmental contamination of food, water and air, and due to their lipophilic properties can accumulate in breast fat. However, it is emerging that the breast is also exposed to a range of oestrogenic chemicals applied as cosmetics to the underarm and breast area. These cosmetics are left on the skin in the appropriate area, allowing a more direct dermal absorption route for breast exposure to oestrogenic chemicals and allowing absorbed chemicals to escape systemic metabolism. This review considers evidence in support of a functional role for the combined interactions of cosmetic chemicals with environmental oestrogens, pharmacological oestrogens, phyto-oestrogens and physiological oestrogens in the rising incidence of breast cancer.

Do underarm cosmetics cause breast cancer?

Although animal and laboratory studies suggest a possible link between certain chemicals used in underarm cosmetics and breast cancer development, there is no reliable evidence that underarm cosmetics use increases breast cancer risk in humans. This article reviews the evidence for and against the possible link between breast cancer and underarm cosmetics and highlights the need for further research to clarify this issue.

Are there differences in breast tissue as a result of hormone replacement therapy? Can BEST imaging distinguish these differences?

Although it has been speculated that estrogen therapy may promote changes in breast tissue that could lead to cancer, no information exists as to differences in breast tissue for women who do and do not take hormone replacement (HRT) therapy. This study seeks to determine if there are differences in the tissue of women taking HRT in contrast to those who do not and if these differences are apparent in cases of breast cancer, cellular atypia, fibrocystic (FCD) disease and normal breasts. A total of 327 non-pregnant, non-lactating, pre-menopausal women were enrolled in the study, including 139 women who were actively taking HRT and 188 women who never had taken HRT. Using breast enhanced scintigraphy test (BEST) imaging, differentiation of breast tissue was determined. The groups were then analyzed to determine the effect of hormone therapy within each category of breast tissue. Differentiation between normal, FCD, cellular atypia, and breast cancer represent statistically significant differences (p.001) in metabolic activity and vascularity as demonstrated by differences in both average count activity (ACA) and maximal count activity (MCA). The distinction between cellular atypia and infiltrating breast cancer was statistically (p.05) different when looking at the maximal activity. Normal breast tissue and breasts with FCD appear more homogenous with no statistical differences in variability in breast tissue. Tissue variability is statistically greater when localized processes, such as cellular atypia and breast cancer, are present. Differentiation of cellular metabolic activity in breast tissue can be statistically determined when looking at the average and maximal metabolic activity. The final distinction between cellular atypia and cancer occurs when a focal region of breast tissue becomes metabolically more active than the surrounding breast tissue as shown by statistical increases in MCA. These findings are confirmed by the increased metabolic variability seen in regions of cellular atypia and cancer compared with the homogenous metabolic activity present in normal and fibrocystic breasts.

Underarm cosmetics and breast cancer

Although risk factors are known to include the loss of function of the susceptibility genes BRCA1/BRCA2 and lifetime exposure to oestrogen, the main causative agents in breast cancer remain unaccounted for. It has been suggested recently that underarm cosmetics might be a cause of breast cancer, because these cosmetics contain a variety of chemicals that are applied frequently to an area directly adjacent to the breast. The strongest supporting evidence comes from unexplained clinical observations showing a disproportionately high incidence of breast cancer in the upper outer quadrant of the breast, just the local area to which these cosmetics are applied. A biological basis for breast carcinogenesis could result from the ability of the various constituent chemicals to bind to DNA and to promote growth of the damaged cells. Multidisciplinary research is now needed to study the effect of long-term use of the constituent chemicals of underarm cosmetics, because if there proves to be any link between these cosmetics and breast cancer then there might be options for the prevention of breast cancer.

Mammary fibroadenomatous hyperplasia in a young cat attributed to treatment with megestrol acetate

A male, neutered cat was presented for lethargy, reluctance to walk, and mammary enlargement after recent treatment with megestrol acetate. Mammary fibroadenomatous hyperplasia was diagnosed on the basis of history, clinical signs, and histopathological findings. Pathogenesis, clinical signs, and treatment options for mammary fibroadenomatous hyperplasia attributed to megestrol acetate treatment are discussed.

Atypical hyperplasia, proliferative fibrocystic change, and exogenous hormone use

BACKGROUND

The association between breast cancer development and exogenous hormone use (EHU) is suggested by indirect clinical evidence. We undertook this study to better define the relationship that EHU has with proliferative fibrocystic change (PFC) and atypical hyperplasia (AH).

METHODS

Women diagnosed with AH without associated carcinoma from January 1990 to December 1999 were compared with control subjects who underwent breast biopsy procedures during the same interval and who were diagnosed with either a proliferative fibrocystic change (PFC) or a nonproliferative fibrocystic change (NPFC). EHU was defined as the use of estrogen or progesterone taken together or separately within 3 months of biopsy.

RESULTS

EHU was significantly higher in patients with AH compared with women with NPFC (P =.01). This observation was also significant if all proliferative change (both AH and PFC) was compared with NPFC (P =.03); it was not significant when PFC alone was compared with NPFC. No significant difference in EHU was demonstrated between women with AH and those with PFC.

CONCLUSIONS

There is strong association between AH and EHU. These results support the theory that a continuum exists between hyperplasia and carcinoma and that EHU may influence the transition from one to the other in an undefined subset of women. We encourage our patients with AH to discontinue EHU.

Mammographic breast density during hormone replacement therapy: effects of continuous combination, unopposed transdermal and low-potency estrogen regimens

OBJECTIVE

The aim of this study was to evaluate the impact of different hormone replacement therapy (HRT) regimens on mammographic breast density.

STUDY DESIGN

Mammographic density was recorded in women participating in a population-based screening program. At first mammogram, all women were non-users of HRT, and thereafter reported continuous use of the same HRT regimen. The study population comprised 158 women: a total of 52 women were using continuous combined HRT (conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 5 mg); 51 women were using low-dose oral estrogen alone (estriol 2 mg daily); and 55 women were using unopposed transdermal estrogen given as a patch (estradiol 50 micrograms/24 h). Films were coded and analyzed for mammographic density by an independent radiologist blinded to treatments. Mammographic density was classified according to Wolfe.

RESULTS

An increase in mammographic density was much more common among women taking continuous combined HRT (40%) than for those using oral low-dose estrogen (6%) and transdermal (2%) treatment. The increase in density was already apparent at the first visit after starting HRT. During long-term follow-up, there was very little change in mammographic status.

CONCLUSION

HRT regimens were shown to have different effects on the normal breast. There is an urgent need to clarify the biological nature and significance of a change in mammographic density during treatment and, in particular, its relation to symptoms and breast cancer risk.

Breast epithelial proliferation in postmenopausal women evaluated through fine-needle-aspiration cytology

OBJECTIVE

The aim was to evaluate fine-needle-aspiration (FNA) cytology as a method of following breast epithelial proliferation in postmenopausal women during hormone replacement therapy (HRT).

METHODS

Twelve healthy postmenopausal women were recruited and randomized to two different types of sequential HRT during 4 months of treatment. The women were administered continuous estradiol 50 micrograms/24 h with the addition of progestogen sequentially in the form of either vaginal progesterone gel 8 mg every 2nd day or medroxyprogesterone acetate 5 mg/day orally during 12 days per month for the complete treatment period. Fine-needle-aspiration biopsies were performed twice during the estrogen phases and twice during the estrogen plus progestogen phases of treatment. Breast epithelial proliferation was analyzed in these samples by immunocytochemistry to measure the content of the nuclear antigen Ki-67/MIB-1, which is expressed in proliferating cells.

RESULTS

From the 12 women, a total number of 47 FNA biopsies were taken. Thirty-eight of these aspirates, 19 from each of the estrogen and the estrogen plus progestogen phases, were evaluable for MIB-1 content (81%). There was a non-significant increase in levels of proliferation during the combined estrogen-progestogen phase (2.1%) compared with the estrogen-only phase (1.4%). These values were similar to those previously observed during the menstrual cycle in young fertile women.

CONCLUSIONS

We conclude that the FNA biopsy technique is feasible for studying proliferation not only in young, normally cycling women but also in the postmenopausal breast.

Fibrous tumor of the breast in a postmenopausal woman receiving estrogen

Fibrous tumor of the breast is a rare, benign stromal proliferation with atrophy of the epithelial component. Almost all patients who develop fibrous tumors are premenopausal. An unusual example of fibrous tumor of the breast is reported in a 62-year-old postmenopausal woman. The mass, first noted 1 year previously, progressively enlarged over the year. The patient noted a history of taking exogenous estrogens for 10 years. Intense estrogen administration during the year of enlargement may be associated with accelerated growth of the tumor. In addition, positive nuclear staining for estrogen receptor antibodies in stromal cells was demonstrated by immunohistochemical methods.

A cohort study of oral contraceptive use and risk of benign breast disease

The purpose of the cohort study reported here was to investigate the association between oral contraceptive use and risk of benign breast disease (BBD), overall and by histological subtype, within the 56,537 women in the Canadian National Breast Screening Study (NBSS) who completed self-administered lifestyle and dietary questionnaires. The NBSS is a randomized controlled trial of screening for breast cancer in women aged 40-59 at recruitment. Cases were the 2,116 women in the dietary cohort who were diagnosed with biopsy-confirmed incident BBD. For comparative purposes, a subcohort consisting of a random sample of 5,681 women (including 197 subjects with incident BBD) was selected from the full dietary cohort. After exclusions for various reasons, the analyses were based on 2,116 cases and 5,338 non-cases. There was an inverse association between use of oral contraceptives and risk of all types of BBD combined. The reduction in risk was confined largely to proliferative forms of BBD (BPED), and in particular, to those forms of BPED without histological atypia, in whom there was a progressive reduction in risk with increasing duration of use (the IRR (95% CI) for use of more than 7 years was 0.64 (0.47-0.87)); risk of BPED with atypia was increased somewhat in association with oral contraceptive use (the IRR (95% CI) for use of more than 7 years was 1.43 (0.68-3.01 )), but not in a dose-dependent manner. The results were similar when examined separately in the screened and control arms of the NBSS and for screen-detected and interval-detected BPED.

[Hormonal contraception and benign breast disease. Evaluation of a treatment protocol for chronic mastopathy with mastalgia]

INTRODUCTION AND AIMS

The aim of this study was to study patients suffering from mammary nodules, fibrocystic disease and mastodynia. Having established the absence of malignant disease, the effect of EP (oestroprogestin) was evaluated in the treatment of fibrocystic disease with mastalgia.

METHODS

From January 1990 to December 1995 a total of 1921 women underwent breast examination at the "Centro di Fisiopatologia della Mammella" in the Division of Gynecology and Obstetrics of Iseo Municipal Hospital. Subjects were aged between 9 and 84 years old. The experimental protocol included a retrospective study of a group of 89 patients suffering from chronic fibrocystic disease with mastalgia with a 3-month follow-up. The clinical examination was commenced by recording the patient's history and the measurement of the thickness of the gland and the evaluation of mastalgia represented important stages of the eco-clinical assessment. The setting for the study was the breast pathology out-patient clinic of the Division of Gynecology and Obstetrics. These women regularly attended our outpatient clinics for the following reasons: depistage, mastodynia, mammary secretion, self-diagnosis of mammary nodules, checkups in patients during follow-up after surgery for genital neoplasia. All patients underwent clinical, echographic and often mammography/X-ray. Patients were selected on the basis of the following criteria: absence of malignant pathology and presence of chronic fibrocystic disease with mastalgia. Of those admitted to the study (no. = 89), only 59 completed the course. In addition to the absence of malignant pathology and the presence of chronic fibrocystic disease with mastalgia, the following parameters were assessed: measurement of the thickness of the mammary gland involving QSE before and after 3-month treatment with EP. The EP used were: gestodene 0.075 mg and etynylestradiol 0.03 mg-Minulet, or etynylestradiol 0.02 mg and dexogestrel 0.150 mg-Securgin and Mercilon.

RESULTS

The response to treatment was classified according to the 4 levels of the Cardiff Breast Score (CBS). The results were relatively good: 35.59% of patients showed a reduction in symptoms; 25.42% showed a marked improvement, and 18.64% a remission of symptoms. No effect was reported in 20.33% of patients.

CONCLUSIONS

In conclusion, it may be said that EP treatment for 3 months can at least be proposed in patients with chronic fibrocystic disease and mastalgia given that a reduction and improvement in symptoms was seen in 60% of patients.

Keratinocyte growth factor causes cystic dilation of the mammary glands of mice. Interactions of keratinocyte growth factor, estrogen, and progesterone in vivo

Keratinocyte growth factor (KGF) is a paracrine mediator of epithelial cell proliferation that has been reported to induce marked proliferation of mammary epithelium in rats. In this study, systemic administration of KGF into naive and oophorectomized mice causes mammary gland proliferation, as evidenced histologically by the appearance of cysts lined by a single layer of epithelium and by hyperplastic epithelium. Whole mount preparations of the mammary glands reveal that the histologically noted cysts are actually ducts that are dilated along much of their length. The histology of the mammary glands of KGF-treated mice is similar to the histology of fibrocystic disease in the human female breast. The response in mice differs significantly from the appearance of the mammary glands in KGF-treated rats in which ductal epithelial proliferation is most prominent. Estrogen and progesterone when administered in combination but not alone cause the development of numerous endbuds in the mouse mammary gland. KGF in estrogen- and progesterone-pretreated mice causes the growth of dilated ducts, hyperplastic epithelium within ducts and endbuds, and a fibrous metamorphosis of periductal adipose tissue. The mammary epithelial hyperplasia caused by KGF is rapidly reversible in both mice and rats after cessation of KGF treatment. The spectrum of KGF-, estrogen-, and progesterone-induced mammary histopathology in mice provides a model for the study of fibrocystic and hyperplastic breast disease.

[Change in the glandular bodies of the breast after hormone therapy. Observations from the radiologic viewpoint]

In the last few years we have recognized a clear change in the mammograms in women undergoing hormone replacement therapy. Not all of them reacted in the same way: 30% on 366 treated patients showed a distinct glandular hyperplasia. Some developed nodes like cysts or adenomas, others had an increase in calcification as a sign of epithelia proliferation, as verified by histological examination. The opposite effect was seen in women receiving antioestrogen therapy as a consequence of breast-conserving therapy. The problems will be illustrated.

[Estrogen-progestin contraception. Disadvantages of estrogen reduction]

Over the past few years a number of new oral contraceptives have come into the market, with the following characteristics: reduced estrogen and progestin levels in order to reduce the incidence of cardiovascular disease, triphasic pills with maximum steroid concentrations coinciding with L.H. surge. These pills enable not only a reduction in progestin levels, but also in intercurrent bleeding. However, low steroid levels could lead to insufficient antigonadotropic effect with endogenous estrogenic secretion in some women. In fact, receptivity of targeted organs to sex steroids varies enormously between individuals. This partial inhibition of ovaries in some women poses problems of short and long term consequences: functional ovarian cysts; less protection than with traditional pills (50 micrograms ethinylestradiol) in terms of ovarian or endometrium cancer, benign breast disease... Only long term comparative and prospective studies, taking into account hormonal status and the degree of fertility and parity would enable the risks associated with these new contraceptives to be established. Consequently, in the light of our present knowledge, we recommend that low-dose oral contraception be avoided: when complete blockage of ovarian activity is required, in women with a history of ovarian cysts.

[Abnormalities of sexual development in Puerto Rico: status report]

Puerto Rico presents the highest incidence in the world of anomalous sexual development. The authors have collected over 3100 cases in the past 19 years. Clinical and laboratory studies suggest possible estrogenic contamination of meats and poultry products. Variation in diet provides protection to a significant number of patients. The possibility of mycotic contamination of food employed in animal husbandry by Fusarium sp., and mycotoxins capable of estrogenic effects have been suggested in a preliminary study. Private and government investigators are active in the study of the condition, but more fiscalizing action is needed. A detailed study of food components for possible contaminants determination is considered mandatory.

[Experimental substantiation of MPEL of dibenz(a,n)anthracene in atmospheric air]

Overt dependence of lung tumour development on the values of the dose administered was shown in experiments on inbred white rats under intratracheal administration of various doses of dibenz (a, h) anthracene (DBA); minimal-effect dose and maximal no-effect dose of DBA were established in the experiment. A theoretically calculated allowable dose was used to calculate MAC of the chemical under study for the ambient air 5 ng/m3 was recommended as an average 24-hour maximum allowable concentration of DBA in ambient air.

Methylxanthines and fibrocystic breast disease: a study of correlations

Daily methylxanthine ingestion from drug and dietary sources was studied by means of questionnaires from a sample of 102 women who visited the office of a radiologist for xeromammograms. The mammograms were used to measure the level of fibrocystic breast disease. Fibrocystic breast disease was found to be positively correlated with both caffeine and total methylxanthine ingestion. These positive findings are discussed in light of the fact that most recent studies of this link have been negative.

[Male transsexualism and hormonal therapy: radiologic pictures of the breast]

Often the male transsexual takes hormonal drugs, sometimes under medical prescription but most frequently by his personal choice. They wish to obtain a development of mammary gland and the disappearance of hair from facial skin. Prolonged hormonal and incorrect treatments, mainly for too high dosage and absence of association with progesterone, assumption of oestrogens, can cause the growth of mammary tumours. The Authors present the results of a clinical and radiological study on 15 patients, 12 in treated with hormonal drugs for two years and 3 without any therapy.

Methylxanthines and benign proliferative epithelial disorders of the breast in women

The relationship between methylxanthine intake (caffeine, theobromine and theophylline) and risk of benign proliferative epithelial disorders (BPED) of the breast was examined in a case-control study conducted in Adelaide, South Australia. The study involved 383 cases with biopsy-confirmed BPED, 192 controls whose biopsy did not show epithelial proliferation, and 383 unbiopsied community controls individually matched to cases on age and area of residence. Overall, there was relatively little variation in risk of BPED with total methylxanthine intake, or with intake of caffeine or theophylline, while there was a positive association between theobromine intake and risk of BPED, but only when cases were compared with biopsy controls. Total methylxanthine intake was positively associated with risk of BPED showing severe atypia, but the trend in risk was statistically significant only when community controls formed the comparison group. These data do not provide strong support for an association between methylxanthine intake and risk of BPED.

Estrogen replacement therapy and fibrocystic breast disease

In a hospital-based case-control study conducted in New Haven, Connecticut, women experiencing estrogen replacement therapy were found to be at twice the risk of nonusers for histologically confirmed fibrocystic breast disease (odds ratio = 2; 95 percent confidence limits = 1-3.9) if their menopause was natural. No excess risk was found for women experiencing a surgical menopause. The highest risk for fibrocystic disease was observed for women with more than three years of estrogen replacement therapy. When therapy occurred was not significantly related to the risk of disease once duration of use was controlled for. These results suggest an etiologic role of estrogen replacement therapy in the development or promotion of fibrocystic breast disease.

Conjugated estrogens and fibrocystic breast disease

The association between replacement estrogen use and subsequent development of fibrocystic breast disease was studied at Group Health Cooperative of Puget Sound. Included were 142 women aged 50-64 years diagnosed by biopsy as having fibrocystic breast disease during the years 1978 through 1983. The relative incidence of hospitalization for estrogen users compared with non-users was 1.9 (95% confidence interval 1.3-2.7). The association became stronger with increasing duration of estrogen use.

Nonassociation of caffeine and fibrocystic breast disease

Fibrocystic breast disease (FBD) is common in women. Caffeine-containing foods and beverages have been implicated as a cause of FBD or as an important factor in its progression. Relationships of causation are difficult to demonstrate. Only rigorous investigational methods can show true association between cause and effect. Our critical review of the medical literature indicated that there is weak evidence for an association between caffeine and FBD. We conclude that physicians need not recommend the avoidance of caffeine in otherwise healthy women who have FBD.

Coffee consumption and fibrocystic breasts: an unlikely association

Caffeine and other methylxanthines have recently come under scrutiny as substances that may cause breast tissue to undergo fibrocystic changes. The authors present a retrospective 5-year study of 358 women with fibrocystic breast disease and a 6-month prospective study of 72 women with this condition. Although methylxanthine consumption was constant, the clinical findings in semiannual or monthly examinations in both studies were inconsistent. On the basis of their results and a review of available studies, the authors believe there is no scientific basis for an association between the consumption of methylxanthines and the development of fibrocystic breast disease.

Theophylline and fibrocystic breast disease

After literature reports linking fibrocystic breast disease (FBD) to methylxanthine ingestion, a pilot study was undertaken to investigate the possible contribution of theophylline to this effect. The major goal of this project was to measure the effect of theophylline therapy on FBD in asthmatic women. All women attending an allergy clinic or an obstetrics/gynecology clinic over a 9-month period were examined to clinically assess FBD and were asked to complete a detailed questionnaire covering health history, other risk factors, and drug and dietary methylxanthines. The sample included 62 asthmatic women, 66 allergic but not asthmatic women, and 72 nonallergic and nonasthmatic women. By use of the FBD clinical taxonomy with its 19-point scale going from 0 to 18 that was developed for this study, the three groups did not differ significantly in terms of mean severity of FBD. On analyzing the effect of each of the methylxanthines on FBD severity, there is clear evidence that total methylxanthines was a contributing factor in FBD severity with or without adjustment for relevant variables, such as age, menopause, pregnancies, and groups. Theophylline was significant only when adjustments were made for age, pregnancy, and menopause in contrast to caffeine that was only significant with no adjustments.

A comparison of pregnancy history recall and medical records. Implications for retrospective studies

Using data from the Diethylstilbestrol-Adenosis (DESAD) Project, a study of the effects of diethylstilbestrol (DES) exposure during fetal life, the authors compared prenatal records with obstetric history from mother's questionnaires completed 10 or more years after the birth of their daughters. Except for the history of hospitalization and trunk x-ray, no differences were observed in agreement (questionnaire compared with record) between the group of DES-exposed mothers identified through review of their prenatal records and the comparison group of mothers who were not exposed. The authors also compared data from mothers of DES-exposed daughters who initiated their own enrollment in the study (walk-ins and referrals). To obtain prenatal records for these women, physicians were contacted. They would usually supply drug exposure data but not the other obstetric history requested. Mothers of these walk-ins and referrals had slightly better agreement between questionnaire and records when compared with the two groups identified by review of prenatal records. In general, there was good to excellent agreement for all groups when mothers' recall of personal history (past miscarriage, past pregnancy, etc.) was compared with their medical records. However, for medical intervention such as drugs and x-rays, agreement was poor. Of the DES-exposed mothers identified through review of their prenatal records, 29% could not remember whether they took DES. An additional 8% said they did not take DES when it was recorded in their charts.

Estrogen replacement therapy and benign breast disease

The relationship between estrogen replacement therapy (ERT) and the risk of benign breast disease (BBD) was examined among 929 postmenopausal cases and 846 postmenopausal controls identified through a large breast cancer screening program. Prior use of ERT among postmenopausal women was associated with an increased risk of both fibrocystic breast disease [odds ratio (OR) = 1.4; 95% confidence interval (Cl) = 1.1-1.8] and fibroadenoma (OR = 1.6; Cl = 0.8-3.5). The risk of all BBD rose with increasing years of use (OR = 1.9 for greater than or equal to 15 yr of total use) and with years since initial use (OR = 1.6 for greater than or equal to 15 yr since first use). Among users of the conjugated estrogen Premarin, increased risks were found at all but the lowest dose. Finally, risks associated with ERT were higher in women with a bilateral oophorectomy than in other postmenopausal women. These results suggested, overall, an increased risk of BBD associated with ERT.

Exogenous hormone use and fibrocystic breast disease by histopathologic component

In a hospital-based case-control study of 590 women with biopsy-proven fibrocystic breast disease and 1,018 control women with other surgical conditions, no linear relationship was evident between the use of oral contraceptives or of estrogen replacement therapy and the degree of epithelial atypia of the fibrocystic lesions. Case-control and intracase comparisons suggested that oral contraceptive use might be associated with an increased occurrence of sclerosing adenosis among the premenopausal women and of gross cysts among the postmenopausal women. Estrogen replacement therapy, which was positively associated with fibrocystic breast disease as a whole among the post-menopausal women, was most frequently used among the cases whose biopsy specimens exhibited gross cysts, papillomatosis or papillary hyperplasia.

Morphological and histological characteristics of mammary dysplasias occurring in cell dissociation-derived murine mammary outgrowths

The morphological and histological characteristics of ductal dysplasias that were observed in mammary outgrowths derived from monodispersed mammary cells of carcinogen-treated mice are described. Mammary outgrowths were derived by injecting either 10(4) or 10(5) enzymatically dissociated mammary cells, obtained from control or carcinogen-treated BALB/c mice, into gland-free mammary fat pads of syngeneic hosts. The mammary dysplasias observed varied considerably in morphological and histological characteristics. The majority of the lesions were ductal in origin and were associated with epithelial hyperplasia which ranged from mild hyperplasia, in which only a few extra layers of epithelium were present, to severe hyperplasia, in which the ducts and end buds were occluded and distended with epithelial cells. In addition, papillary and lobular lesions were observed which were also associated with varying degrees of hyperplasia. The range of mammary dysplasias observed in these outgrowths closely resembles that of lesions associated with the pathogenesis of mammary carcinoma in mice, rats, and humans.

Factors influencing expression of mammary ductal dysplasia in cell dissociation-derived murine mammary outgrowths

The expression of mammary ductal dysplasia has been shown to be enhanced in mammary outgrowths derived from enzymatically dissociated mammary cells and influenced by the number of cells used to derive the outgrowths. The present study was designed to examine this cell dose effect further and to determine if the developmental state of the outgrowths or the time between carcinogen administration and cell dissociation affects the expression and persistence of the ductal dysplasias. Mammary outgrowths were derived by injecting 10(4) or 10(5) enzymatically dissociated mammary cells into gland-free fat pads of 3-week-old female BALB/c mice. Donor animals were untreated or were exposed to either 7,12-dimethylbenz(a)anthracene or gamma-ray irradiation. The outgrowths were examined at 4.5, 8, 10, or 16 weeks after transplantation, depending on the experiment, and classified as having normal or dysplastic growth. The data indicated that expression of ductal dysplasia was greater in outgrowths derived from 10(4) than from 10(5) cells regardless of the developmental state of the outgrowths. When 24 hr elapsed between carcinogen exposure and cell dissociation, expression of lesions in outgrowths derived from 10(4) cells required active ductal growth, in that lesions that were present in developing outgrowths remodeled and were no longer detectable when the outgrowths completely filled the fat pad. When second-transplant-generation outgrowths were derived from cells of full (non-growing) first-generation outgrowths, ductal dysplasias were reexpressed but, once again, only within developing outgrowths. Increasing the time between carcinogen treatment and cell dissociation, i.e., 6 days or longer, resulted in both increased frequencies of ductal dysplasias and substantial numbers of lesions which persisted within full outgrowths. These results suggested that the acquisition of the altered growth potential which resulted in ductal dysplasias and the ability of these lesions to gain some autonomy from growth-regulatory mechanisms were separate events that occurred at different times after carcinogen treatment.

Prospective study of "fibrocystic breast disease" and caffeine consumption

Conflicting reports have appeared in the recent literature on a presumed association between coffee intake and "fibrocystic breast disease." The hypothesis suggesting that abstention from coffee and caffeine consumption eliminates breast pain and resolves breast nodules was based on an uncontrolled clinical study. For a condition with a notorious reputation for "waxing and waning," it is essential to document the stability versus instability of clinical findings, keeping the methyl xanthine consumption constant. Seventy-two women, all with palpable breast nodules, were followed over a 6-month period with monthly examinations and questionnaires on intake of coffee, tea, soft drinks, chocolate, candies, and caffeine-containing drugs. The methyl xanthine consumption remained remarkably constant throughout the observation time. The examiner was uninformed as to previous examination findings and pain reports of each woman. In 21 (15%) breasts with nodularity, the nodules had completely disappeared by the termination of the study. A total of 125 (87%) breasts of the sample manifested a change in the number of nodules or a change in position. Forty-eight of the 72 women were menopausal. For a chronic condition with so much variety of subjective sensitivity and great variability of objective clinical palpation, it is difficult to relate the amount of methyl xanthine consumption to "fibrocystic breast disease."

Oral contraceptives and benign breast disease: a case-control study

The relationship between benign breast disease and use of oral contraceptives was analyzed in a case-control study conducted in Milan with 288 cases of clinically relevant and histologically confirmed benign breast disease and 285 age-matched controls with a spectrum of acute conditions apparently unrelated to use of oral contraceptives. Compared to the risk for women who had never used oral contraceptives, the relative risk for users was 1.0 (95% confidence interval: 0.6 to 1.5). There was no significant association with duration of use; however, a significantly lower relative risk was found in women using oral contraceptives during the year before breast biopsy (relative risk: 0.4; 95% confidence interval: 0.2 to 0.8). The protection in current users increased with increasing duration of use. In spite of this finding, the overall results of the present study do not support the hypothesis that oral contraceptive use protects against development of histologically confirmed and clinically relevant benign breast disease.

The relationship of estrogen and progesterone to breast disease

The rising incidence of breast cancer, coupled with awareness of the effects of hormones on breast tissue, has resulted in fears that estrogen, progesterone or both incite or adversely affect benign and malignant breast disease. An intensive review of the hormone physiology of the breast and of the numerous studies on hormones and breast disease reveals that estrogen and especially oral contraceptives not only do not cause breast cancer but may have a slight protective effect. Also, the overwhelming evidence is that the risk of benign breast disease is substantially reduced in both current and prior users of oral contraceptives.

Oral contraceptive use and fibrocystic breast disease among pre- and postmenopausal women

The association between use of oral contraceptives and fibrocystic breast disease was assessed among women aged 20-74 years in a hospital-based case-control study conducted between November 1979 and November 1981 in Connecticut. The study groups comprised 633 women with biopsy-proven fibrocystic breast disease and 1,062 controls who had been admitted, as inpatients or outpatients, to general surgical services. For the premenopausal women, there was no evidence that long-term use of oral contraceptives was associated with a decreased frequency of fibrocystic breast disease among either current or past users. For the postmenopausal women, previous oral contraceptive exposure was associated with an increased occurrence of cystic disease. These findings contradict previous investigations reporting a negative association between oral contraceptive use and the development of fibrocystic breast disease.

Hormone and methylxanthine action on breast epithelial cells

Human mammary carcinoma cells and normal mouse breast epithelial cells desensitized as the result of treatment with beta-adrenergic agonists. Accumulation of cAMP in the same cells was affected only slightly by caffeine and there was no detectable desensitization or hypersensitization as a result of that treatment. However, as in many other cell types, caffeine was an effective inhibitor of adenosine action. These observations do not support the hypothesis made by Minton and his co-workers (1), that treatment of breast epithelial cells with agents that increase cAMP accumulation leads to hypersensitization rather than desensitization.

Oral contraceptive use and fibrocystic breast disease with special reference to its histopathology

The relationship between use of oral contraceptives and fibrocystic breast disease was examined in a hospital-based case-control study undertaken in New Haven, Connecticut, from 1977 to 1979. Particular emphasis was placed on the extent of epithelial atypia and other histopathologic characteristics found in the biopsy specimens from the cases. Women who had ever used oral contraceptives were at a somewhat decreased risk for fibrocystic disease as a whole. Cases with high atypia and controls had similar patterns of oral contraceptive use, whereas cases with low and intermediate atypia had less oral contraceptive use than controls. Cases with intermediate atypia reported the lowest oral contraceptive use. Subjects with biopsy specimens exhibiting gross cysts, microscopic cysts, or papillomatosis were about 50% less likely to have used oral contraceptives than controls.

The health consequences of caffeine

Acutely administered caffeine modestly increases blood pressure, plasma catecholamine levels, plasma renin activity, serum free fatty acid levels, urine production, and gastric acid secretion. It alters the electroencephalographic spectrum, mood, and sleep patterns of normal volunteers. Chronic caffeine consumption has no effect on blood pressure, plasma catecholamine levels, plasma renin activity, serum cholesterol concentration, blood glucose levels, or urine production. Caffeine does not appear to be useful for increasing the motility of hypomotile sperm in artificial insemination or in the therapy of minimal brain dysfunction, cancer, or Parkinson's syndrome, but it may be effective as a topical treatment of atopic dermatitis and as systemic therapy for neonatal apnea. Caffeine does not seem to be associated with myocardial infarction; lower urinary tract, renal, or pancreatic cancer; teratogenicity; or fibrocystic breast disease. The role of caffeine in the production of cardiac arrhythmias or gastric or duodenal ulcers remains uncertain.

Identifying and tracing a population at risk: the DESAD Project experience

In recent years, medical record review has been used to alert patients who have received drugs or treatments that have newly discovered side-effects. The experience of the national cooperative Diethylstilbestrol-Adenosis (DESAD) Project in identifying and notifying women exposed in utero to diethylstilbestrol (DES) shows this to be a difficult task. In order to identify 4,830 exposed women, 221,245 charts were reviewed. Detailed tracing data for one of the centers participating in the DESAD Project indicated that only 85 per cent of the 690 DES-exposed women identified at that center could be notified of exposure. The DESAD Project experience has led to recommendations for standardized prenatal records and drug lists, long-term storage of medical records, new legal guidelines, and improved recording of follow-up information, taking into account issues of privacy.

Non-contraceptive exogenous estrogens and risk of breast cancer: a review

Results from epidemiologic and related studies of non-contraceptive estrogens and breast cancer are reviewed. Exogenous estrogens in high doses can enhance the risk of breast cancer. Moderate use of estrogens for menopausal symptoms probably has little effect on risk, but long-term users, and women who take high-strength preparations, appear to be at slightly increased risk. Exogenous estrogens probably reduce the protective effect of premenopausal oophorectomy, and may preferentially enhance the risk of breast cancer in women with some types of benign breast disease, although data from some studies do not support these conclusions. There is no evidence that the influence on risk of breast cancer is different for synthetic and conjugated estrogens. Needs for reanalysis of data from existing studies, and for additional investigations, are summarized.